MEDICARE: RESIDENTIAL ALTERNATIVES OF ILLINOIS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0047324	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083692420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL ALTERNATIVES OF ILLINOIS INC

Provider Business Mailing Address
First Line	:	140 N 6TH ST
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-1878
Country	:	US
Telephone Number	:	815-875-6600
Fax Number	:	815-875-6005

Provider Business Practice Location Address
First Line	:	140 N 6TH ST
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-1878
Country	:	US
Telephone Number	:	815-875-6600
Fax Number	:	815-875-6005

Authorized Official
Title or Position	:	CFO
Name	:	MR. RONALD J WILSON
Credential	:
Telephone Number	:	309-343-1550

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	04/28/2010

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Directions to “RESIDENTIAL ALTERNATIVES OF ILLINOIS INC ” Practice Location

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